OBJECTIVE: To describe the characteristics of children seeking emergency care for firearm injuries within the PECARN network, and assess the influence of both individual and neighborhood factors on firearm-related injury risk. METHODS: This was a retrospective, multicenter cross-sectional analysis of children (<19-years-old) presenting to 16 pediatric EDs (2004-2008). ICD-9-CM E-codes were used to identify and categorize firearm injuries by mechanism/intent. Neighborhood variables were derived from home address data. Multivariable analysis examined the influence of individual and neighborhood factors on firearm-related injuries as compared to non-firearm ED visits. Injury recidivism was assessed. RESULTS: 1,758 pediatric ED visits for firearm-related injuries were analyzed. Assault (51.4%, n=904) and unintentional injury (33.2%, n=584) were the most common injury mechanisms. Among children with firearm injuries, 68.3% were older adolescents (15-19 years-old), 82.3% male, 68.2% African-American, and 76.3% received public insurance/were uninsured. Extremity injuries were most common (75.9%), with 20% sustaining injuries to multiple body regions, 48.1% requiring admission, and 1% ED mortality. Multivariable analysis identified firearm injury risk factors, including adolescent age (p<0.001), male gender (p<0.001), non-Caucasian race/ethnicity (p<0.001), public payer/uninsured status (p<0.001), and higher levels of neighborhood disadvantage (p<0.001). Among children with firearm injuries, 12-month ED recidivism for any reason was 22.4%, with <1% returning for another firearm injury. CONCLUSION: Among children receiving ED treatment within the PECARN network, there are distinct demographic and neighborhood factors associated with firearm injuries. Among younger children (<10 years old), unintentional injuries predominate, while assault-type injuries were most common among older adolescents. Overall, among this PECARN patient population, male adolescents living in neighborhoods characterized by high-levels of concentrated disadvantage had an elevated risk for firearm injury. Public health efforts should focus on developing and implementing initiatives addressing risk factors at both the individual and community level, including ED-based interventions to reduce the risk for firearm injuries among high-risk pediatric populations. This article is protected by copyright. All rights reserved.